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This case report describes an ascending aortitis presentation in a 25-year-old man with chest pain, abnormal EKG findings, fever, leukocytosis, thrombocytosis, and elevated liver enzymes, alongside imaging evidence of pulmonary involvement and pericardial effusion. Despite extensive infectious and rheumatologic testing, including negative cultures and serologies aside from Coxsackie virus positivity, histopathology demonstrated a predominantly neutrophilic infiltrate without an inciting microorganism. The report emphasizes that neutrophilic infiltrates in ascending aortic aneurysms do not necessarily indicate infectious etiology.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/noninfectious-necrotizing-aortitis-with-predominantly-neutrophilic-infiltrate/458332/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/noninfectious-necrotizing-aortitis-with-predominantly-neutrophilic-infiltrate/458332.png","ImageObject",300,407,{"name":92,"@type":93},"Alex Sinclair","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What distinguishes noninfectious necrotizing aortitis from infectious aortitis in this report?","Question",{"text":112,"@type":113},"The case emphasizes that histopathology showed a predominantly neutrophilic infiltrate without an inciting microorganism, despite broad infectious workup.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What symptoms and initial clinical findings did the 25-year-old patient present with?",{"text":117,"@type":113},"He presented with worsening chest pain radiating to the left arm, mild tachycardia, new T wave inversions, fever, leukocytosis, thrombocytosis, and elevated AST/ALT.",{"name":119,"@type":110,"acceptedAnswer":120},"What tests were performed to evaluate possible infectious or rheumatologic causes, and what were the results?",{"text":121,"@type":113},"The patient underwent infectious and rheumatologic testing, including negative blood cultures, negative rheumatologic markers such as ANA and anti-dsDNA, and negative BAL cultures for AFB and fungi; BAL was positive for Coxsackie virus and other serologies were negative.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},458332,1790752607,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":39,"preview_page_count":4},1099523882182,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Wiley  \nCase Reports in Pathology  \nVolume 2026, Article ID 5727208, 3 pages [https://doi.org/10.1155/crip/5727208](https://doi.org/10.1155/crip/5727208)  \nCase Report  \nNoninfectious Necrotizing Aortitis With Predominantly Neutrophilic Infiltrate  \nNathan A. Williams , 1 Mark Colantonio ,2 Anastasia Miller, 1 and Allen P. Burke 1  \n1Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA  \n2Department of Internal Medicine, West Virginia University School of Medicine, Baltimore, Maryland, USA  \nCorrespondence should be addressed to Nathan A. Williams; [nathanawilliams96@gmail.com](nathanawilliams96@gmail.com)  \nReceived 11 February 2025; Revised 1 December 2025; Accepted 15 December 2025  \nAcademic Editor: Suraiya Saleem  \nCopyright © 2026 Nathan A. Williams et al. Case Reports in Pathology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nAortitis can be either infectious or noninfectious, and cases of noninfectious aortitis are not well understood. Our study presents a case of noninfectious ascending aortitis in a relatively young, previously healthy man, characterized by a predominantly neutrophilic infiltrate on histopathological examination without an inciting microorganism. This case report highlights that aneutrophilic infiltrate does not necessarily indicate an infectious etiology in ascending aortic aneurysms.  \n1. Introduction  \nAortitis can present in many different ways and encompasses a wide spectrum of pathological findings, including infectious or noninfectious etiologies [1] . Commonly, cases of aortitis are due to large vessel vasculitides, including giant cell arteritis (GCA) and Takayasu arteritis. Historically, infectious aortitis was most commonly secondary to Treponema pallidum and primarily affecting the ascending aorta. Infectious aortitis is most frequently a complication of bacteremia and often associated with endocarditis, leading to fever and leukocytosis [2] . Infectious aortitis is mostly seen in the descending thoracic aorta. Etiologies include Staphylococcus aureus, Streptococcus, and other Gram-negative bacilli [3]. Histological evaluation can be essential for differntiating infectious versus noninfectious cases ofaortitis. Ramiro et al. described a case of infectious aortitis in an elderly female with evidence of neutrophilic infiltrates on vascular wall histology, whereas Miller et al. conducted a retrospective review of 45 cases of confirmed noninfectious aortitis and described chronic inflammation characterized by the presence of multinucleated giant cells and mononuclear cells, including lymphocytes and macrophages [4, 5] .  \nThe etiology of noninfectious aortitis remains poorly understood and is often presumed to be autoimmune in eti-  \nology [6] . Noninfectious aortitis can be classified into several major disease classifications, while giant cell/granulomatous aortitis (including Takayasu aortitis) is the most common [6] . Other etiologies include lymphoplasmacytic aortitis (including IgG4-related sclerosing and rheumatologic disease), granulomatosis with polyangiitis (GPA), sarcoidosis, Cogan syndrome, and Behçet disease [6] . Most cases of noninfectious aortitis are incidental and represent 6% of ascending aortic aneurysm repairs [7] .  \nLiterature has outlined four main histological patterns of aortitis, including granulomatous or giant cell pattern, lymphoplasmacytic pattern, mixed inflammatory pattern, and suppurative pattern [8] . However, noninfectious aortitis with a predominantly neutrophilic inflammatory response has not been reported. We report a case of noninfectious ascending aortitis with suppurative features, resulting in the absence of an inciting microorganism. Pathologists and treating physicians should be aware that a neutrophilic infiltrate does not necessar","cbCailfNzZZefxQv","https://ap.wps.com/l/cbCailfNzZZefxQv","pdf",692198,"English","# Introduction\n# Case","[{\"question\":\"What distinguishes noninfectious necrotizing aortitis from infectious aortitis in this report?\",\"answer\":\"The case emphasizes that histopathology showed a predominantly neutrophilic infiltrate without an inciting microorganism, despite broad infectious workup.\"},{\"question\":\"What symptoms and initial clinical findings did the 25-year-old patient present with?\",\"answer\":\"He presented with worsening chest pain radiating to the left arm, mild tachycardia, new T wave inversions, fever, leukocytosis, thrombocytosis, and elevated AST/ALT.\"},{\"question\":\"What tests were performed to evaluate possible infectious or rheumatologic causes, and what were the results?\",\"answer\":\"The patient underwent infectious and rheumatologic testing, including negative blood cultures, negative rheumatologic markers such as ANA and anti-dsDNA, and negative BAL cultures for AFB and fungi; BAL was positive for Coxsackie virus and other serologies were negative.\"}]","Noninfectious Necrotizing Aortitis With Predominantly Neutrophilic Infiltrate | PDF"]